1. OVERVIEW OF RETIREE MEDICAL BENEFITS
Employee Services Agency Employee Benefits Department
Fiscal Year 2017
July 1, 2016 to June 30, 2017

2. Agenda Retiree benefits provided by the County
How to qualify for retiree medical
Cost of retiree medical
Options for living out-of-state
Medicare
Exit Interview
Retirement planning check list
Questions

3. Retiree Medical Benefits Provided by the County of Santa Clara
Medical premium payment equivalent to 100% of the Kaiser plan for the retiree only. Exec Mgrs: 100% of lowest cost plan.
Retiree pays the difference for a higher cost plan.
Retiree pays the difference to provide coverage for spouse or dependent.

4. What is not Provided by the County?
Dental or Vision Insurance
Options for retirees
COBRA for a maximum of 36 months
Individual plan
Retired Public Employees’ Association - (800)
Liberty Dental
Covered CA or another state’s health care marketplace.

5. What is not Provided by the County?
Life Insurance and Long-Term Disability
Basic and Supplemental Life insurance policies can be converted to a personal policy.
Retirees are provided with contact information for conversion of life insurance plans at the time of the Exit Interview with Employee Benefits.
Long-Term Disability insurance cannot be continued after employment ends.

6. How Do Employees Qualify for Retiree Medical Coverage?
Must be regular coded with continuous employment and meet the following age and days of service requirement:
If hired prior to 8/12/96:
50 years of age and have 5 years of service (1305 days)
If hired between 8/12/96 and 06/18/06
50 years of age and have 8 years of service (2088 days)
If hired on or after* 06/19/06:
50 years of age and have 10 years of service (2610 days)
* Some union agreements require 15 years of service (3915 days) – check your MOA to see if this applies to your effective hire date.

7. How Do Employees Qualify for Retiree Medical Coverage? Cont.
Must retire from CalPERS and the County on the same date (move directly from “employee” status into “retiree” status).
Enrollment in retiree medical coverage is not automatic.
Schedule to attend an Exit Interview at least 60 days before your retirement date.

8. Retirees’ Cost for Medical coverage
Sample of monthly retiree-only cost:
Rates shown are effective July 1, 2016 through June 30, 2017
* VHP “Classic” rates include a partial subsidy for FY17
Plan
No Medicare
Exec Mgrs w/Medicare
All Others w/Medicare
Health Net POS in California
$473.59
$398.56
$31.83
Health Net FlexNet Indemnity
$1,495.54
$525.19
$158.46
Health Net Nationwide PPO
$863.58
$543.39
$176.66
Valley Health Plan “Classic” *
$65.78
$321.80
$15.09
Valley Health Plan “Preferred”
$0.89
$274.25
$0.00
Kaiser Permanente HMO

9. Retirees’ Cost for Spouse Coverage
Sample of monthly cost for retiree + spouse: (Medicare rates assume both retiree & spouse have Medicare)
Rates shown are effective July 1, 2016 through June 30, 2017
* VHP “Classic” rates include a partial subsidy for FY17
Plan
No Medicare
Exec Mgrs w/Medicare
All Others w/Medicare
Health Net POS in California
$999.55
$1,136.25
$769.52
Health Net FlexNet Indemnity
$2,913.75
$1,389.51
$1,022.78
Health Net Nationwide PPO
$1,618.01
$1,425.91
$1,059.18
Valley Health Plan “Classic” *
$948.68
$1,088.04
$781.33
Valley Health Plan “Preferred”
$707.66
$887.63
$613.38
Kaiser Permanente HMO
$705.85
$339.13

10. What are the Options for Coverage Outside of California?
Retirees may choose to enroll in one of the following out-of-area plans:
Health Net
Coverage available nationwide.
PPO Plan
Health Net FlexNet Indemnity Plan
Point of Service plan not available nationwide.

11. What are the Options for Coverage Outside of California?
Kaiser – Non Medicare Retirees
Must be enrolled in Kaiser at the time of his/her move. Can receive Emergency/Urgent medical care.
Retirees must travel to California for coverage for routine care (subject to change).
Kaiser – Medicare Retirees
No longer qualify for Kaiser coverage.

12. What are the Options for Coverage Outside of California?
Valley Health Plan
Available only in Santa Clara, San Mateo, Alameda, Stanislaus, Merced, San Benito, Monterey, Santa Cruz and San Francisco counties.
No medical plan coverage is available outside of the United States.

13. What is the Payment In Lieu Of Medical Coverage?
Available to retirees permanently residing outside of California and the U.S.
Must waive enrollment in a County sponsored medical plan
Must provide proof of enrollment in any other medical plan

14. What is the Payment In Lieu Of Medical Coverage?
County pays retiree, on a quarterly basis, an amount equal to the amount County contributes for retiree medical coverage: $ per month for FY17
Amount is taxable form sent to participant after the end of the calendar year

15. Can Retirees Change Medical Plans After Retirement?..
Yes, during the annual open enrollment period
May 1st to May 31st
Can change health plan
Add or drop eligible dependents
All changes go into effect on July 1st

16. Can Retirees Change Medical Plans After Retirement?..
Yes, if you have a qualifying event, such as:
Move away from the service area covered by your current medical plan
Marriage, divorce or add a child.
Any change must be made within 30 days of the qualifying event.
Contact Employee Benefits to make a change.

17. Does Spouse and/or Dependent Medical Coverage Continue After Retiree Death?
The County offers survivor coverage under the following conditions:
The Spouse and/or dependent is covered on the retiree's health plan at the time of death.
The spouse and/or dependent pays 100% of the group premium in a timely and in a consistent manner.
The County does not contribute towards survivor coverage.

18. Medicare Overview For information about Medicare www.medicare.gov
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.
For information about Medicare
1-800-MEDICARE

19. What Medicare Part A Covers
Hospital care
Skilled nursing facility care
Nursing home care (as long as custodial care isn't the only care you need)
Hospice
Home health services

20. What Medicare Part B Covers
Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Part B covers things like:
Clinical research  
Ambulance services
Durable medical equipment (DME)
Mental health
Getting a second opinion before surgery
Limited outpatient prescription drugs

21. Retirees over age 65
Retirees and/or their spouse eligible for Medicare parts A & B must enroll!
Retirees and/or their spouse with Medicare A&B are required to elect a County sponsored Medicare coordinating Medical Plan within their current plan.
Retirees or spouse must not enroll in the Medicare Part D - Prescription Drug Program.

22. Retirees over age 65
Employee Benefits must receive a copy of the Medicare B card.
If you or your spouse are already receiving Social Security benefit payments, they will send you these cards automatically
If you or your spouse are not receiving Social Security benefit payments, you must enroll by your 65th birthday.
Notify Employee Benefits as soon as you enroll in Medicare.

23. How to enroll in Medicare A & B
Apply online at Social Security.
Visit your local Social Security office.
Call Social Security at

24. Medicare Part B Reimbursement
All retirees (except UAPD & Executive Management) are eligible
Amount: the difference between what the County pays for retiree-only coverage and the cost for the retiree’s elected Medicare health plan, up to the actual cost to the retiree for their Medicare Part B premium.
This is a negotiated benefit and subject to change.

25. Medicare Part B Reimbursement
To be approved for the program retirees must:
Provide a copy of their Medicare Card
Complete a Statement of Understanding
Be enrolled in a Medicare coordinating health plan or have waived medical coverage.

26. Medicare Part B Reimbursement
The County sends payment to enrolled retirees on a quarterly basis (at the end of the month following quarter’s end).
Quarters are Jan - Mar, Apr - June, July - Sept & Oct - Dec.
Participation begins on the month after required documents are received.
Retirees who have waived medical coverage will receive the full amount they pay for Medicare Part B. Proof of payment amount is required.

27. Exit Interview Plan to attend an Exit Interview session:
Overview of retiree medical benefits
Completion of County forms
Completion of Medical Enrollment Forms
COBRA information

28. Retirement Planning Checklist
Submit Retirement Application to CalPERS. 3 months before retirement.
Schedule appointment to attend Retiree Exit Interview months.
Apply for Medicare A & B, if you are over age months.
Attend Exit Interview months before retirement.
Inform your Supervisor/Manager of your retirement date. 1 month -2 weeks
Inform your department Employee Service Center month – 2 weeks.

29. How do I contact the County Employee Benefits Department?
70 West Hedding St., 8th Floor
San Jose, CA 95110
(408) or
(800) – toll free